Provider Demographics
NPI:1629145305
Name:PERSON COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:PERSON COUNTY HEALTH DEPARTMENT
Other - Org Name:OUTREACH AND CLINIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:O
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-597-2204
Mailing Address - Street 1:355 S MADISON BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-5485
Mailing Address - Country:US
Mailing Address - Phone:336-597-2204
Mailing Address - Fax:336-597-4804
Practice Address - Street 1:355 S MADISON BLVD
Practice Address - Street 2:STE A
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5485
Practice Address - Country:US
Practice Address - Phone:336-597-2204
Practice Address - Fax:336-597-4804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF PERSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-29
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404421Medicaid